Impact of cognitive impairment on functional outcome in stroke.

The aim of this study was to investigate the effect of the cognitive impairment on functional status in patients with subacute stroke. Fifty-two patients with subacute stroke were included in the study. Mini mental state examination (MMSE) test was used for the evaluation of cognitive status. Patients were separated into two groups according to their cognitive functions. Functional follow-up parameters were activities of daily living (ADL), global recovery and ambulation status. All patients were evaluated on admission to rehabilitation unit, at discharge and 6 months after discharge. Forty-four patients were completed the study. Mean age was 66 and 57 years; disease duration on admission was 4,8 and 3,5 months in the cognitively impaired and normal groups, respectively. Significant improvement was found in terms of functional follow-up parameters in both groups at discharge (P < .05). Functional follow-up parameters did not show statistically significant difference between the groups. But community ambulation rate was higher in cognitively normal group at the sixth month visit. As a result of this study, inpatient rehabilitation was effective both cognitively normal and impaired subacute stroke patients.

Relationship between bone turnover and bone density at the proximal femur in stroke patients.

OBJECTIVE: To investigate the relationship between the rate of bone turnover and bone loss at the proximal femur in stroke patients. METHODS: This study was performed between January 1, 2005 and August 31, 2006 at the Stroke Rehabilitation Unit, Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey. One hundred six patients who had a stroke for the first time were included in the study. The control group consisted of 33 age- and gender-matched healthy subjects. Bone mineral density (BMD) was measured at the proximal hip region by dual energy X-ray absorptiometry (DXA). Serum osteocalcin (OC) and C telopeptide of type 1 collagen (CTX) levels were measured. Barthel Index (BI) was used for the evaluation of daily activities. Ambulation status of the patients was recorded. RESULTS: Mean age was 65.1 +/- 9.8 years in the patient group and 51% were male. Mean disease duration was 16.9 +/- 9.1 months. Mean BI score was 60.5 +/- 25.8 on admission. Femoral neck BMD values were 0.873 +/- 0.95 g/cm(2) and 0.816 +/- 0.180 g/cm(2) for control subjects and hemiplegic sides of the patient group, respectively. Femur total BMD values were 0.948 +/- 0.119 g/cm(2) and 0.872 +/- 0.187 g/cm(2) for control group and hemiplegic sides of the patients, respectively. Femoral neck and femur total BMD values in the hemiplegic side were lower than those of controls' (P < .05). There was no statistically significant difference between the proximal femur BMD values of the intact and hemiplegic sides. Negative correlation was found between the proximal femur BMD values of both the intact and hemiplegic sides, and serum OC and CTX levels. Bone resorption rate was higher among the patients with stroke; however, bone formation rate was normal in this group. Serum CTX levels showed correlation with ambulation status. Femoral neck BMD values on the intact side were lower in the patient group with disease duration of more than 1 year compared to those with shorter disease duration. CONCLUSION: As a result of this study bone turnover was inversely correlated with bone density at the hip of both hemiplegic and intact sides in stroke patients. Evaluation of bone turnover might be helpful to predict bone loss and to find out the stroke patients with bone loss who can not be decided to begin antiresorptive treatment with bone density measurement.

Comparison of the therapeutic efficacy of TENS versus intra-articular hyaluronic acid injection in patients with knee osteoarthritis: a prospective randomized study.

Knee osteoarthritis (OA) is perceived as a major public health problem, and today, various treatment modalities are used to manage this condition. The purpose of this study was to assess and compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and intra-articular hylan G-F 20 (Synvisc; Genzyme Corporation, Ridgefield, NJ) in patients with symptomatic knee OA. A total of 60 patients with primary knee OA were randomized into 2 treatment groups. TENS was applied for 3 weeks in the first group, and in the second group, hylan G-F 20 was injected intra-articularly once a week for 3 weeks. Patients were then followed for 6 months. Disease severity was measured with the Lequesne Index. Efficacy in terms of pain, functional status, and quality of life was assessed through analysis of changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and short Form 36 Health Survey (SF-36) scores. Adverse events were monitored throughout the study. WOMAC pain scores were improved at the first control visit in the TENS group and in the viscosupplementation group; this improvement was statistically significant. WOMAC stiffness scores showed a statistically significant decrease in the TENS group at the first control visit. Stiffness did not decrease during the first month in the second group; however, these patients exhibited improvement during the sixth month after injection. Physical function scores and SF-36 total scores did not change in either group after treatment. Pain relief was observed at the first month and continued throughout the 6-month follow-up period in both groups. Stiffness decreased by the sixth month in both groups. Improvement in WOMAC physical function scores was greater in the intra-articular hylan group than in the TENS group at the end of follow-up; however, quality of life was not improved in either group. These therapies used in combination may alleviate symptoms in patients with OA.